Awareness and confidence of family physicians in recognition and treatment of psychiatric disorders

OBJECTIVES: This paper aims to evaluate the competence and confidence of the primary care practitioner in the recognition, diagnosis and treatment of mental disorders.METHODOLOGY: A validated 13 point questionnaire which incorporated items from the DSM IV was given to the participants of the annual convention of the Philippine Academy of Family Physician held in Davao City Sept 8-10, 2000.RESULTS: Four hundred eighty five family physicians returned the self administered questionnaire. Fifty one percent (248/ 485) claimed they would immediately refer patients to the psychiatrist while 28% (137/ 485) would initiate treatment on their own. Fourteen percent (68/ 485) and 10.9% (53/ 485) of the respondents indicated that they were familiar with the DSM IV criteria for schizophrenia and depression respectively; however only 11.3 % (55/485)were confident in using the criteria for diagnosis. Fortytwo percent (204/485) described schizophrenic patients as being irritable and aggressive, 30% (146/485) believed that hallucinations were the hallmark symptom, while 18% (88/485) considered bizarre behavior as the most significant indicator of schizophrenia. For depression the subjective feeling of sadness and worthlessness was most indicative of depression for the respondents (63% or 305), while 21% or 102 considered low self esteem or unstable self image as one of the criteria for depression and 16% or 78 thought of diminished interest or pleasure in all activities as the more important symptom to look for when diagnosing depression. Tricyclic antidepressants were still the preferred drug by most family physicians in treating depression (72% or 340) while 62% (301/ 485) prescribed benzodiazepines and 51% (248/ 485) also used the newer selective serotonin reuptake inhibitors. Patients with schizophrenia would be given typical psychotropic drugs like chlorpromazine or haloperidol more commonly (88% or 427), while 46% (224/ 485) had begun to prescribe atypical antipsychotic medications.CONCLUSION:The family physician seems to be hesitant or unsure with their diagnosing or treating psychiatric patients though willing to administer psychotropic medications.

Quantitative and morphologic analysis of lymphocytes and macrophages in the cerebrospinalfluid (CSF) of first onset and chronic schizophrenia

OBJECTIVES: The aim of this study is to compare the White Blood Cell count and morphology in the Cerebrospinal fluid of:1) patients diagnosed with first onset treatment naive schizophrenia; 2) patients with chronic schizophrenia and 3) healthy subjects.METHODOLOGY: CSF samples from 16 chronic schizophrenics, 15 first onset treatment naive schizophrenics and normal controls were collected and analyzed by histopathology.RESULTS: The cytological profile of CSF cells were significantly different from those of the control population. Total cell count was significantly higher in patients with first onset and chronic schizophrenia compared to normal subjects except in neutrophils. There was also a difference in the mean number of cells among groups, with chronic schizophrenics having the most number of large lymphocytes compared to first onset schizophrenia and control groups. The number of macrophages and neutrophils were not statistically significant.CONCLUSION: The finding of atypical lymphocytes in the CSF suggest that immunologic aberration does occur in schizophrenia and point towards a chronic degenerative process.